感染症と治療ジャーナル

抽象的な

Factors Associated with Confirmed Tuberculosis Treatment Outcome: A Hospital Study Cohort in Dakar, Senegal

Louise Fortes Déguénonvo, Viviane Marie Pierre Cisse Diallo, Khardiata Diallo Mbaye, Agbogbenkou Tévi Déla Lawson, Ndeye Aïssatou Lakhe, Daye Ka, Assane Diouf, Ndeye Fatou Ngom Guèye, Cheikh Tacko Diop, Massaly Aminata, Allasane Dieye, Sylvie Diop-Nyafouna, Cheikh Tidiane Ndour and Moussa Seydi

Context: In order to break the chain of tuberculosis transmission, all diagnosed cases must be followed until the treatment is complete. Several factors influence the treatment outcomes, particularly in hospitals where care is provided for patients with the most severe cases.

Methodology: The purpose of this retrospective cohort study was to analyze the evolution of the treatment outcomes from 2011 to 2015 and identify factors associated with unsuccessful TB treatment. Tuberculosis cases confirmed by bacteriology and/or by Xpert-MTB/Rif test, being treated in the Department of Infectious and Tropical Diseases at Fann University Hospital in Dakar, were included. The trend Ch² test was used to measure the evolution of treatment outcomes from 2011 to 2015 and logistic regression for the identification of the factors associated with unsuccessful TB treatment.

Results: We collected 413 confirmed tuberculosis cases. The average age of patients was 38 ± 12 years and the sex ratio: 1.3. Most patients of the 46.4% cases were admitted to hospital. The average weight during the beginning of the treatment was 51 ± 10.8 kg. The isolated pulmonary TB represented 86.2%, followed by the multifocal TB 11.8%. Patients receiving retreatment were 8.2%. The HIV seroprevalence was 60.67%. Bacilloscopy confirmed tuberculosis in 75% of the cases and the Xpert-MTB/Rif test in 25%. From 2011 to 2015, the percentage of patients with successful TB treatment has increased from 47.4% to 69.3% (p=0.006). Lost to follow up patients have decreased from 18.4% to 7.4% (p=0.04). Unsuccessful TB treatment was associated to hospitalization at TB diagnosis (AOR=7.15; 95% CI: 4.23 – 12.10), low weight when starting the treatment (AOR=0.33; 95%CI: 0.14 – 0.77), and co-infection with HIV (AOR=2.07; 95% CI: 1.17 – 3.71).

Conclusion: Overall, progress has been made in monitoring patients who have been treated for tuberculosis. However, the favorable outcome percentage could be increased by improving the nutritional condition of patients and intensifying early screening and fighting against HIV infection.